Unraveling the mystery of the aging upper neck

June 18, 2014

Improving the contour of the aging neck requires more than a skillful technique, said Fred Fedok, M.D., F.A.C.S., of the McCollough Plastic Surgery Clinic, Gulf Shores, Ala., and Pennsylvania State University, Hershey, Pa., during his presentation, “Unraveling the mystery of the aging upper neck,” at Vegas Cosmetic Surgery 2014. The neck, he argued, has an aesthetic all its own.

Improving the contour of the aging neck requires more than a skillful technique, said Fred Fedok, M.D., F.A.C.S., of the McCollough Plastic Surgery Clinic,Gulf Shores, Ala., and Pennsylvania State University, Hershey, Pa., during his presentation, “Unraveling the mystery of the aging upper neck,” at Vegas Cosmetic Surgery 2014. The neck, he argued, has an aesthetic all its own.

Citing Amedeo Clemente Modigliani, an Italian painter well known for painting portraits with characteristic necks, Dr. Fedok said that both the shape and condition of the neck are part of a person’s character, and can reflect, perhaps, even as much about them as facial characteristics do. In Modigliani’s work, he pointed out, the neck mirrors the personality of the subject painted. The neck reveals whether that person is sophisticated and elegant, robust and hardy, youthful or aged.

To create the aesthetic neck requires an understanding of the key components, Dr. Fedok said. These include a well-defined jawline, underlying musculature and anatomy. If the neck is too heavy, it hides desirable aesthetic definition; if it’s too thin it looks cadaveric, which isn’t attractive. There’s also the condition of the skin and skeletal features to consider. How much adipose is in the neck?

“It’s the surgeon’s job to analyze these characteristics and put everything together,” Dr. Fedok said.

The key in doing so lies in the aesthetic process: performing an aesthetic analysis on each individual patient, understanding the anatomical issues, and importantly, matching the technique to the patient.

Start from the bottom up, he advised. Ask yourself about:

  • Improving skeletal characteristics;

  • Changing anatomic structures;

  • Addressing the skin and SMAS.

Perhaps it’s not as much a mystery, after all, as it is a process, Dr. Fedok concluded. If you evaluate the patient aesthetically, understand what belies the aesthetic features, and understand the anatomy, you are more likely to know how to repair and optimize the neck.

“The sophistication of the management is not only in the execution of technique. Superb results, however, are had from matching the right approach with the right patient, and bringing it all together.”

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